KALAELOA — Indonesia has experienced more than 100 deaths from avian flu, officials said. So a simulated exercise conducted yesterday by military and civilian authorities was an opportunity to plan for the worst.

The scenario involved a fictional commercial airliner, en route from Jakarta to Mexico City, that crashed on Midway Island. Then, the injured that were evacuated to Hawai'i started experiencing flu-like symptoms.

The Midway crash simulation was realistic in its execution, with more than 200 military and civilian responders and an elaborate evaluation and quarantine operation at the Kalaeloa airport.

"What we're doing is forward-deploying the ability to test for flu at the airport," said state epidemiologist Dr. Paul Effler. "Hawai'i was really one of the first places to look at this and say, 'Hey, our public expects us to try to stop this at the airport.' "

The "Lightning Rescue" exercise, which officials said is one of the most ambitious of its kind held in the United States, simulated a Boeing 767 being diverted to Midway after a bird strike and then crashing on the atoll.

According to the scenario, the most critically injured were airlifted by the military on Tuesday to Honolulu hospitals. With a Coast Guard C-130 aircraft en route to Hawai'i with the remaining injured and emergency responders yesterday, it was learned that some may possibly be avian flu victims.

The C-130, which did not actually fly to Midway, was outfitted with stretchers that hung on scaffolding set up in the cargo bay.

With three armed Customs and Border Protection officers wearing masks and goggles guarding the exterior of the aircraft, seven patients on stretchers, including one who had died, and three walking wounded were taken off the aircraft.

A "blind" girl was among the group, along with several big stuffed animals representing family pets.

The patients were taken to a series of tents, and at the first, their temperatures were taken and a triage assessment was made, including affixing tags to some that read "contaminated."

In a second treatment tent, a man in a white shirt and dark pants said, "Doctor, help me, I can't breathe" as he lay on a gurney. Another man in shorts was placed in a clear plastic inflatable isolation bag with portholes that was connected to an air flow.

Elsewhere in the Hawai'i National Guard hangar, a quarantine site was set up, with victims lying on stretchers and on cots in large field tents.

Toby Clairmont, director of emergency medical services for the Healthcare Association of Hawai'i, said a holding facility could be in place for several weeks in the event of a real outbreak involving air passengers. Clairmont had a supervisory role with the Disaster Medical Assistance Team during the five-day exercise ending tomorrow.

Effler said Honolulu Airport has two gates — 33 and 34 — designated as holding spots should a plane land with suspected ill people aboard.

Approximately 75 people have been checked at the airport since November 2005, and of those, there were 12 positives for flu but none for avian flu, Effler said.

"We don't pretend that you can stop all cases of avian flu from entering," he said, " ... but we think it is absolutely reasonable that you would attempt to identify ill people, and if so, attempt to isolate them so that they can get the care that they need and at the same time protect the people in the community and hospitals."

Part of the exercise included rechecking injured airline passengers for bird flu who had been taken to O'ahu hospitals on Tuesday before flu symptoms were identified.

The exercise included military participants as well as federal, state and city responders, among them the U.S. Centers for Disease Control and Prevention, Federal Aviation Administration, and state Civil Defense and Health Department.

A key organizing role in responses is held by the military's Joint Task Force-Homeland Defense at Fort Shafter, whose mission is to respond to terrorist threats and provide assistance in the event of disasters.

Lt. Col. Ed Toy, who is with the joint task force, said the military presence for exercises like "Lightning Rescue" is in support of civil authorities.

Toy said the No. 1 lesson learned from exercises like the plane crash "is communications — the ability to achieve what we call a common operating picture."

"Lightning Rescue" is the third big exercise held in the past several years to test disaster readiness. A smaller response exercise last year focused on an air disaster on Wake Island, Toy said.

Reach William Cole at wcole@honoluluadvertiser.com.